Stroke

Stroke Types

There are two major types of stroke: hemorrhagic and ischemic. A hemorrhagic stroke refers to bleeding occurring in the brain or in the space surrounding the brain (subarachnoid hemorrhage). Although bleeding in other spaces surrounding the brain may occur (subdural, epidural), this is usually not considered a stroke. An ischemic stroke occurs when there is occlusion of a blood vessel, resulting in lack of blood supply to an area of the brain and death of brain tissue (infarction). These two types of stroke, hemorrhagic and ischemic, have different possible mechanisms.

Risk Factors

Non-Modifiable: Things You Can't Change

Previous Stroke or TIA
Age
Gender
Race
Family history

Modifiable: Things You Can Change

High blood pressure #1 risk factor
Smoking
Atrial fibrillation
Diabetes
Physical inactivity
Being overweight / have obesity
High cholesterol
Alcohol and drug abuse

Stroke Prevention

After a stroke occurs, the most effective way to prevent a recurrent stroke (secondary prevention) is to treat risk factors. Vascular risk factors include diverse diseases and conditions that have been associated with increased risk of stroke.

There are risk factors that can be modified and others that are non-modifiable. Treatment focuses on influencing modifiable risk factors, including hypertension, diabetes, hyperlipidemia, smoking, physical inactivity, obesity and carotid artery disease.

When a patient has a stroke, the next step after acute treatment is provided is to attempt to identify the most likely cause of the stroke. Patients undergo different tests including imaging of the brain with computerized tomography (CT), and/or head magnetic resonance imaging (MRI) and of the blood vessels of the neck and head with angiography (CTA, MRA, and angiogram), transcranial doppler, and/or carotid ultrasound, and of the heart with TTE and/or TEE. In addition, several blood tests are obtained to evaluate blood sugar, lipid levels, and other conditions that may increase the risk of stroke. The type of tests recommended will vary for each patient, depending on the individual circumstances. Identification of the stroke type and mechanism will lead to specific therapies in most cases.

Regardless of the type of stroke, assessment for the presence of modifiable vascular factors is done in every patient. If present, effective treatment of these risk factors will reduce the risk of recurrent stroke. However, effective treatment implies achieving therapeutic goals, which in turn depends on patient understanding of treatments, compliance with medications and recommendations, and close follow up with a vascular neurologist and primary care physician.

The benefit of treating risk factors may vary, depending on the type of stroke.

Physical Activity and Stroke Prevention

A sedentary lifestyle is associated with an increased risk of stroke, and it does complicate recovery in patients who have suffered the stroke. Although the precise mechanisms underlying this association are uncertain, exercise improves control of other risk factors (high blood pressure, abnormal blood lipid levels, and diabetes). The American Heart Association recommends regular physical activity to eliminate some of the risk factors for stroke. Specifically, regular moderate physical activity (jogging, hiking, running, biking, brisk walking) can reduce high blood pressure, increase "good" cholesterol, and help to loose weight and lower the risk of diabetes.

Guidelines by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health recommend moderate exercise for 30 minutes on most, and preferably all, days of the week. In the case of stroke prevention, the benefits are apparent even for light to moderate activities, such as walking and gardening, and the data support additional benefit from increasing the level and duration of such an activity.

Stroke Warning Signs

The following are common symptoms of stroke. If you are experiencing any of these symptoms, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately.

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

If you suspect that a family member or loved one is suffering a stroke, it is important to act F.A.S.T. Ask the person to do the following:

Face - check for facial droop or an uneven smile
Arm - observe if one arm lags behind, or is not raised as high as the opposite arm. Also check to see if the person is unable to maintain both their arms at equal height.
Speech - Ask them to repeat a simple sentence, such as "today is a sunny day." Check if the person's speech is altered or slurred, or if they have difficulty understanding.
Time - Call 911 and get to the hospital immediately.

It is possible that these symptoms occur transiently for several minutes or a few hours and may go away. This could be a transient ischemic attack (TIA) and is considered a mini stroke. Do not ignore any of the warning signs as they are considered high risk that another stroke may occur. Please call for medical help immediately.